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Emergency coronary artery bypass surgery after chronic total occlusion percutaneous coronary intervention: Insights
Deniz Mutlu1, Athanasios Rempakos1, Michaella Alexandrou1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Insights
Emergency coronary artery bypass surgery (eCABG) after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) occurred in 0.12% of cases. This complication, often due to coronary perforation, was linked to significantly higher mortality.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Emergency coronary artery bypass surgery (eCABG) is a critical complication following percutaneous coronary intervention (PCI) for chronic total occlusions (CTO).
- Understanding the incidence and predictors of eCABG is crucial for improving patient outcomes in complex PCI procedures.
Purpose of the Study:
- To determine the incidence and outcomes of eCABG in patients undergoing CTO PCI.
- To identify patient and lesion characteristics associated with eCABG.
Main Methods:
- A multicenter registry analysis of 14,512 CTO PCI procedures performed between 2012 and 2023.
- Comparison of demographic, lesion, procedural, and outcome data between patients who did and did not require eCABG.
Main Results:
- The incidence of eCABG was 0.12% (17 patients).
- Coronary perforation was the primary reason for eCABG (70.6%).
- eCABG was associated with higher rates of in-hospital mortality (35.3%), coronary perforation, pericardiocentesis, and major bleeding, along with lower technical and procedural success.
Conclusions:
- eCABG is a rare but severe complication of CTO PCI, with a 0.12% incidence.
- Coronary perforation is the leading cause of eCABG, which carries a substantial risk of mortality and other adverse events.
Background:
Emergency coronary artery bypass surgery (eCABG) is a serious complication of chronic total occlusion (CTO) percutaneous coronary artery intervention (PCI).
Methods:
We examined the incidence and outcomes eCABG among 14,512 CTO PCIs performed between 2012 and 2023 in a large multicenter registry.
Results:
The incidence of eCABG was 0.12% (n = 17). Mean age was 68 ± 6 years and 69% of the patients were men. The most common reason for eCABG was coronary perforation (70.6%). eCABG patients had larger target vessel diameter (3.36 ± 0.50 vs. 2.90 ± 0.52; p = 0.003), were more likely to have moderate/severe calcification (85.7% vs. 45.8%; p = 0.006), side branch at the proximal cap (91.7% vs. 55.4%; p = 0.025), and balloon undilatable lesions (50% vs. 7.4%; p = 0.001) and to have undergone retrograde crossing (64.7% vs. 30.8%, p = 0.006). eCABG cases had lower technical (35.3% vs. 86.7%; p < 0.001) and procedural (35.3% vs. 86.7%; p < 0.001) success and higher in-hospital mortality (35.3% vs. 0.4%; p < 0.001), coronary perforation (70.6% vs. 4.6%; p < 0.001), pericardiocentesis (47.1% vs. 0.8%; p < 0.001), and major bleeding (11.8% vs. 0.5%; p < 0.001).
Conclusions:
The incidence of eCABG after CTO PCI was 0.12% and associated with high in-hospital mortality (35%). Coronary perforation was the most common reason for eCABG.
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